Marlys K Proctor, P.T.A.

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A00840 Issued in KY

Practice address

200 Hester Rd
Portland, TN 37148-4901

Phone

(615) 888-2088

NPI assigned

Jun 28, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386841864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HESTER RD",
            "city": "PORTLAND",
            "state": "TN",
            "postal_code": "371484901",
            "telephone_number": "615-888-2088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HESTER RD",
            "city": "PORTLAND",
            "state": "TN",
            "postal_code": "371484901",
            "telephone_number": "615-888-2088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "MARLYS",
        "middle_name": "K",
        "name_prefix": "Mrs.",
        "credential": "P.T.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "KY",
            "license": "A00840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Portland Primary Care, LLC
• Portland Surgical, LLC (Portland Surgical)
• Portland Wellness Center PLLC
• Precision Chiropractic of Portland
• Premise Health of Tennessee Medical PC (Unipres - Portland)
• Progressivehealth Healthspot
• Ralph H. Ruckle, MD
• Red Spruce Emergency Physicians, PLLC
• Andrea Reed, NP
• Justin Tyler Reid, OD

• Physical Therapy Assistant in Portland, TN
• Providers in Portland, TN by specialty
• Physical Therapy Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.